Categories
Complementary and alternative medicine Medicine Politics Popular culture Pseudoscience Quackery

The next frontier in “integrative medicine”: Getting Medicaid to fund quackery

Naturopaths are not the only relentless quacks seeking to bend government to legitimize their quackery. Acupuncturists are now working to get Medicaid to fund acupuncture services. They are succeeding.

Well, I’m back.

I didn’t realize it until New Year’s Day, but it has been nearly two weeks since I last wrote a post that was about anything other than puppies. Of course, my traffic would probably be very much higher if all I wrote about is fostering puppies and how outrageously cute they are, but that’s not what I’m about. Also, the puppies will be heading to the shelter on Sunday to be put up for adoption. I expect they’ll go fast to good forever homes, and I will deeply miss the little buggers.

It is the dawn of a new year, and in early January my thoughts, as is the case for many people, often turn to what sorts of tasks and plans I need to do and develop for the year ahead. Last year, as is the case with most years, had a lot of pseudoscience and quackery to deal with, including the horrible news that Susan and Henry Samueli donated $200 million to the University of California, Irvine to establish an integrative medicine program that will likely be larger than any in the world, a potent force to “integrate” pseudoscience and quackery into medical schools. On the other hand, the year ended with the FDA releasing proposed regulatory guidance on homeopathy that would (finally!) regulate homeopathic remedies as drugs, leading me to ask if 2018 would finally be the year when this happens. I certainly hope so.

However, on December 31, I saw a rather disturbing story that tells me that those of us supporting science-based medicine still have our work cut out for us. I also found it disturbing because I lived in Cleveland for eight years. Even though I havne’t lived in Ohio for 20 years, my wife and I still have friends there, and we still have an attachment to the state given that my wife’s family is from northwest Ohio. Basically, Ohio is opening up its Medicaid program to acupuncture quackery:

Starting January 1, more than 108,000 Ohioans on Medicaid who have diagnosed low back pain or migraines will be able to see an acupuncturist for pain management. The change in policy is part of an effort to reduce the number of unnecessary opioid prescriptions and overdose deaths in the state that arise from treating chronic pain with addictive drugs.

For the past year, Ohio has been one of six states in the country to cover acupuncture treatments for Medicaid patients, but only when offered by a doctor. Starting tomorrow, Medicaid reimbursement will be open to licensed non-physician acupuncturists who register as Medicaid providers.

The agency hopes that expanding access to the treatment, a centuries-old pain-relief technique that involves inserting hair-thin needles into the skin at specific points, will save money over time on addiction treatment and other costs related to opioid use.

Practitioners and their patients say it’s about time more people had access to the proven and safe, but expensive, non-drug therapy, and that more insurers should follow suit.

The opioid crisis is the new “wedge” being used by promoters of “integrative medicine” quackery, who are taking advantage of the search for non-opioid and non-pharmacologic treatments for chronic pain to promote their placebo-based pseudoscience as the solution to the crisis. It’s become one of the main talking points used by advocates to open the door for the “integration” of mystical, prescientific, and pseudoscientific treatments like acupuncture into medicine. Indeed, whenever you hear the terms “non-drug therapy” or “nonpharmacologic management of pain” used by advocates with respect to the opioid crisis and chronic pain management, it’s code for placebo-based quackery. The quacks are not even subtle about it.

It’s a rationale that comes right from the top, from the most prominent proponents of “integrative medicine.” For instance, the National Center for Complementary and Integrative Health (NCCIH) featured the opioid crisis as a compelling reason for its existence in its latest five year strategic plan, which made the “nonpharmacologic management of pain” one of its top research priorities. Since then, NCCIH has been promoting such approaches, science-based or quackery like acupuncture, as its own, the better to seamlessly integrate pseudoscience with science. Elsewhere, the same sort of rationale is used to justify the introduction of quackery into the VA medical system, while even prestigious journals like The BMJ and JAMA buy into the message. Even the FDA is considering encouraging knowledge about chiropractic and acupuncture as approaches for chronic pain.

It’s not just NCCIH, either. There are professional societies jumping on the bandwagon as well. For instance, the American College of Physicians included acupuncture on its list of recommended strategies for low back pain. An entire professional organization, the Society for Integrative Oncology, is devoted to diluting the science of oncology with a mixture of lifestyle interventions that are in no way “alternative” or “integrative” plus pseudoscientific nonsense. Even NCI-designated comprehensive cancer centers like Memorial Sloan-Kettering Cancer Center are increasingly “integrating” quackery with oncology. And don’t even get me started on “naturopathic oncology,” which is becoming increasingly accepted and metastasizing outside of academia.

Meanwhile, back in Ohio:

Dr. Maya Myslenski, a pediatrician who practices in the emergency department at MetroHealth Medical Center, has been offering acupuncture to her patients for a variety of ailments for more than two years. It helps patients with both acute and chronic pain, anxiety, and some stomach ailments, she said.

“A lot of our [Medicaid] patients can’t afford to go to private offices for treatments,” Myslenski said. “I’m beyond thrilled about treatments being covered for them.”

Noooo! During my residency at University Hospitals of Cleveland, I did part of my training at MetroHealth Medical Center, particularly for trauma. I moonlighted as a helicopter flight physician for Metro LifeFlight, which is based at MetroHealth Medical Center.

Unfortunately, this article is quite credulous about acupuncture, repeating the usual tropes used to justify it:

In Ohio, the move to cover acupuncture for chronic pain conditions began in earnest in January of 2016, when Gov. John Kasich’s Cabinet Opiate Action Team (GCOAT) released a guideline for the management of acute pain outside of emergency departments. The guideline said that non-drug therapies such as acupuncture (as well as physical and massage therapies, biofeedback and hypnotherapy) should be considered as first-line treatments for acute pain. The Governor’s team also encouraged Medicaid to further research and review acupuncture.

Then in January of 2017, the Joint Commission, the not-for-profit organization that certifies hospitals have met certain safety standards, changed its pain management standards to require that accredited hospitals provide nonpharmacological pain treatments.

Around the same time, the American College of Physicians issued new guidelines for the treatment of low back pain, which recommended that doctors treat patients with non-drug therapies first, including acupuncture.

One more time: The ACP guidelines were poorly conceived and based on weak science. I’ve also mentioned the Joint Commission’s recommendations before. While it’s not unreasonable to promote the use of nonpharmacological approaches to pain, those approaches must be science- and evidence-based. So far, advocates of unscientific approaches like acupuncture have been getting away with using the opioid crisis as a cover to advance their quackery and even get the government and insurance companies to pay for it. They’re not even subtle about it:

“It may take another year or so, but I do think it’s going to lead to a change in policy,” he said. “The opioid crisis has helped the establishment catch up a little to research on acupuncture. There’s been a big change in attitude in terms of openness to this sort of thing.”

The person making the above statement is Robert Davis, a Vermont acupuncturist who led the state’s pilot testing acupuncture for back pain. Yeah, that gives me a lot of confidence in the scientific validity of the pilot studies being done in various states. I note that his website basically relies on testimonials to claim that acupuncture “works”; well, that and “ample clinical experience, supported by some research data.”

I also can’t help but note that even the author of this story lazily cites a “meta-analysis” from the Australian Acupuncture and Chinese Medicine Association that was not published in any peer-reviewed journal as “evidence” for the efficacy of acupuncture, as he lays down quotes like:

West said the research on acupuncture has become much clearer in recent years, both on how well it works and how it can save money.

“There are some really big, recent studies that clearly show that acupuncture is not only comparable to Western medicine in how effective it is, but it’s safer and it’s cost-effective,” West said. “In chronic low back pain, you can save money over the long-term, give people just as good care and they’re not getting addicted to pain medication.”

It costs the insurer between 70 cents and $1 per month, per policy, to add acupuncture coverage, West said. “It just doesn’t make sense not to when we’re spending $1 billion a year in Ohio on addiction treatment.”

No, when you’re spending $1 billion a year on addiction treatment for Ohio residents, it doesn’t make sense to waste money on ineffective and pseudoscientific treatments. What’s next? Narconon? Also, no, there are not “really big, recent studies that clearly show that acupuncture is comparable to “Western” medicine, much less cost effective. In general, most studies of acupuncture tend to be relatively small, poorly controlled, and equivocal in results, while meta-analyses of acupuncture studies are generally the epitome of “garbage in, garbage out.” In general, the larger and better designed the acupuncture study, the smaller the effect, with the effect size being in essence zero in the very best studies. Moreover, it doesn’t matter where you place the needles or even if you place the needles in; the effect is the same, nonspecific. Acupuncture doesn’t work. It is theatrical placebo.

As for Jared West, who was quoted above, he’s an acupuncturist, of course. Not surprisingly, he offers acupuncture, moxibustion, and cuppingquackery. He’s also president of the Ohio Association of Acupuncture and Oriental Medicine and is helping providers navigate the Medicaid registration process and has advised the state on reimbursement and other issues.

And now Medicaid in Ohio will pay for it, but it’s not only Ohio. Six states thus far cover acupuncture under their Medicaid program, California, Oregon, New Jersey, Massachusetts and Minnesota, with Maine and Vermont considering whether to cover the treatment for their Medicaid patients after completing pilot studies testing its effectiveness, largely, it appears, based on popularity:

“We had a waiting list in pretty short order,” said Davis. Pain, sleep disturbance, fatigue, functioning, depression and anxiety all improved for patients in the pilot study, he said. While historically most people who use acupuncture as a treatment have had higher-than-average income and education levels, the Vermont study suggests this is only because they’re the ones who could afford it, Davis said.

One wonders if this pilot study had a control group. My guess is that the answer is no. My guess was correct, it turns out. This pilot study was a “pragmatic trial,” with no blinding and no control group. As I’ve pointed out time and time again, acupuncturists love pragmatic trials, because they allow placebo effects to appear to be real effects.

In 2018, look for more of this. Just like naturopaths, acupuncturists are using the opioid crisis as an opportunity to legitimize their profession, the way that naturopaths are using the opioid crisis as a strategy to justify obtaining licensure in more states. Quacks, be they naturopaths or acupuncturists, are just like The Terminator in that they are relentless. They can’t be bargained with. They can’t be reasoned with. And they absolutely will not stop until science-based medicine is dead.

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

52 replies on “The next frontier in “integrative medicine”: Getting Medicaid to fund quackery”

I agree with you that fake treatments with bad evidence are not the solution. Especially given the ethical issues with a treatment based on tricking people. I mean, if you want to offer open placebos, why not have a hot spa or tub, maybe followed by massage? Much more fun than needles, and don’t need to pretend it’s science.

But we do need a solution for pain management that doesn’t involve opioids, as you already say. Until we have one, this is going to be really hard to counter.

Are you keeping any puppies?

I also admit I’m a little troubled by the fact that right now access to these treatments is regressive. Why should only the rich get access to the expensive placebo?

Of course, that’s not a good reason to channel money that can be used for real treatments there.

Why should only the rich get access to the expensive placebo?

It’s one thing for the rich to spend their own money on expensive placebos. It’s quite a different matter to spend taxpayer money on expensive placebos. The harm in the former case is limited to the person spending his own money. In the latter case, scarce resources are being shifted away from effective treatments to treatments that line the pockets of the practitioners.

It’s true that there is at present no good solution to the opioid problem. People in pain are going to find ways to reduce that pain, including self-medicating with substances for which the body can build up a tolerance (that applies to ethanol as well as prescription painkillers). On top of that you have towns with no visible means of economic support, and the people who live there are going to find something to do. Ohio has many such towns, as does upcountry Maine. These places are likely to see increases in criminal activity as people become ever more desperate for their fix. Already I no longer feel safe in Oxford County, Maine. There are many other places that would probably give me a similar vibe, but I haven’t been to those places, while Oxford County is only about 1.5 hours from where I live. And I don’t get that vibe in notoriously seedy urban neighborhoods like San Francisco’s Tenderloin or Third Avenue in Seattle.

Thread Jack
On a positive note, Quack-supporter in chief, Orin Hatch is retiring this year. (http://www.cbc.ca/news/world/orrin-hatch-senate-retirement-1.4470232) The forces of idiocy will be losing a powerful ally in the US Senate. So at least there is a bright spark this year.
/Thread Jack

I think this falls under the heading of “We have to do something” about the opiod issue. Unfortunately, politicians like the big splashy show vs doing actual work to solve a problem. A flash in the pan gets them votes, where as the long slow slog loses the public’s interest quickly.

How much of the opioid crisis is actually the result of patients becoming addicted to appropriately prescribed painkillers? I’ve seen articles suggesting that there is a significant problem with illegally obtained fenanyl, and that illegally imported fenanyl rather than prescribed opioids is really the problem. I suspect it’s not that simple, never the less how much of the opioid crisis is the result of either route is surely something that it is important to know before applying any solution.

I found a couple of references that the incidence of chronic pain prescibees make up a very small (2-3% ?) of overdose hospital admissions. I think that the street drug/fentanyl crisis is confused with presciption opioids into a general opioid panic. Abuse of prescription narcotics is definitely a problem but there are procedures to screen patients at risk for addiction/abuse and it definitely is not a justification for spending a lot of money on magic. Using those funds to deal with the mental health issues that underlie many addictions would help way more people more effectively.

A decade or so ago there was a big problem with oxycontin, a prescription opioid, being regularly stolen in drug store burglaries. I don’t know how much of that was former prescription users who had become addicted, versus those who were recreational users from the get-go. The problem got so bad that oxycontin got the nickname “hillbilly heroin”, and some of the worst affected areas are the same areas that now have serious problems with opioids. Drug stores learned to take special security precautions with oxycontin, so problems with that particular drug have abated.

I’m sure that there are a few Dr. Feelgood types out there, but because of the fear of getting patients addicted, painkiller prescriptions are particularly heavily regulated. Most doctors have an interest in not overprescribing, and I hear anecdotally that many are in fact underprescribing because they do not want to risk their licenses over questionable opioid prescriptions.

But that solution creates other problems: what do patients who feel (often with justification) that they are being underprescribed do?

The correlation between drug problems (not just opioids but meth as well) and lack of economic opportunity is a point in favor of the proposition that much of the problem is due to recreational use. If you are living in an old factory town that has lost its factory, you have no other nearby job prospects, and you either cannot or will not move elsewhere, what are you going to do with your time?

<

blockquote>I’m sure that there are a few Dr. Feelgood types out there

<

blockquote>

Perhaps you are unfamiliar with this thing known as “Florida.”

I’ve seen articles suggesting that there is a significant problem with illegally obtained fenanyl, and that illegally imported fenanyl rather than prescribed opioids is really the problem.

Let’s not forget imported carfentanil.

I’ve seen remarkably little actual useful information to aid my understanding of the matter. I have seen loud cries about evil doctors and big pharma being at the root of the problem and also the more reasoned analyses that suggest that such is not the case.

My impression is that fentanyl is turning up in street drugs because it is very cheap to produce. The therapeutic index (more or less the ratio of amount that causes harm to that which controls pain) for fentanyl is actually really high – somewhere around 400. It is spectacular for carfentanil – up in the thousands. Morphine is around 70; heroin a bit over 100. I have no idea how these numbers relate to the high produced.
I very strongly suspect that many deaths are largely due to a combination of the extreme potency of the drugs and the incompetent cowboys who brew up the mixtures for street sales. Even assuming accurate measurements, making homogeneous mixtures of powders is difficult. With something as potent as carfentanil, the difference between a safe dose and a lethal dose is a teenie tiny granule. Think of homeopathy – those few starting molecules will go somewhere. If something were so potent that one molecule would be fatal, you wouldn’t want to be the stiff to get the sugar pill that actually had one stuck to it. The Alberta government was smugly patting itself on the back for banning possession of pharmaceutical powder mixtures a little while ago. No, idiots – you want the blendors (blending vendors?) to have the very highest performance equipment available, not a spoon and a bowl. “Blotters” carefully made one by one are probably much less likely to contain more than expected.

Police crow about seizures from “drug labs” and like to tell everyone that they risk instant death from overdose in the process (yet somehow they never seem to find labs littered with bodies). I have yet to see a single report of careful analysis of the goods, done in a way that reveals anything about the uniformity of distribution of the active ingredient in the diluent. Maybe it is being done, but maybe important opportunities to gather useful information are being lost.

This is off the topic of the present post, but worth noting that the arguments you make here are the same arguments against herbal remedies: poor control over the concentration of the active ingredient.

Orac writes,

Well, I’m back.

MJD says,

It’s ironic that Orac would reference a line from J.R.R Tolkien’s trilogy: The Lord of the Rings (lotr).

The lotr is steeped in non-conventional medicine allegory.

https://hubpages.com/literature/lotr-healing

Q. What character is Orac most like in the lotr.

A. Grima Wormtongue.

Orac discards integrative medicine like Grima Wormtongue discarded the Palantir.

Orac discards integrative medicine like Grima Wormtongue discarded the Palantir.

Go patent your dong and write a book about it, Douchniak.

MJD of course is something like Gollum, blundering around in the dark and being generally unpleasant, but unlike in not killing trolls but supporting them.

Comparing Orac to Grima and integrative medicine to the palantir- both inappropriate and clumsy

the palantir is a useful artefact that reveals distant events albeit sometimes in an obscure manner and Grima is a lying manipulator trying to usurp the king’s power
whilst integrative medicine is an attempt by charlatans to appear more respectable and Orac Is the one who uncovers their lies and manipulations

Grima is throwing away something valuable because he is a hothead
Orac is carefully explaining why discarding IM’s fantasy based portions is necessary for SBM

It’s MJD’s cowardly way of calling Orac a liar

Denice Walter writes,

It’s MJD’s cowardly way of calling Orac a liar.

MJD says,

If I thought Orac was a liar I wouldn’t have been such a loyal commenter for the last 8 years.

Facts:

There are 93 US Patents (01/04/2018) with the term “integrative medicine” somewhere therein.

There are 125 patent publications (01/04/2018) with the term “integrative medicine” somewhere therein.

It appears that integrative medicine is no stranger to innovation.

MJD:

If you don’t think Orac is a liar ( and a manipulator ) why do you compare him to a character who exemplifies those qualities? If you compare someone to a despicable character, you’re calling him or her despicable as well.

A comparison highlights things IN COMMON.- there’s no other reason to make it. .

Denice,

Orac is a reflection of Grima Wormtongue based on the act of discarding something useful in a harmful fashion.

Specifically, Orac’s inclination to describe integrative medicine as “quackery” is to encompassing and insolent.

It continues to be my wish that Orac will, one sunny day, allow me to write a post for Respectful Insolence.

It has been written that Orac’s ego is too great by far to allow another to share his space, barring extraordinary circumstances.

@ Orac,

Would you allow MJD such an honor?

You’d think acupuncture could perhaps be some biological plausibility, as acupuncture needles are made from steel having a nebulous ‘electron sea’ which could influence nerve conduction. However, it has been pointed out to me that historical acupuncture needles were made of bone—a fact which deftly throws acupuncture into one of either two groups: one consisting of quackery that had ironically turned out to work, as steel replaced bone; or full‐blown quackery proper in every sense of the word. I suspect the latter, although some aspects of biophysics (EM) could have potential and should be studied in greater detail.

a fact which deftly throws acupuncture into one of either two groups

Dear f*cking G-d, Travis, you don’t even know how the “meridians” got moved?

some aspects of biophysics (EM) could have potential

The “electron sea”? No?

<

blockquote>and should be studied in greater detail

<

blockquote>

Buy a mirror, or an introductory E&M textbook.

You have to admit, Narad, that electromagnetic radiation can affect the body. DNA has been shown to have a resonant frequency in the infrared–microwave range, leading one to ponder if it could increase influence replication.

After reading about microtubules, I think you’d accept the possibility that the body could respond to even visible light—sans pineal of course. I certainly don’t condone Hulda Clark woo, but let’s be honest: There certainly are biological effects from non‐ionizing radiation that could be further studied, both out of basic scientific interest and to be used as evidence in legal claims.

I understand that there is a crisis with opioids and I would love to see a good solution, but using public money to pay for needle sticking, isn’t it. Furthermore, I take a mild opioid for my chronic pain, every day. I can’t take NSAIDs and Prednisone has so many side effects and has already adversely affected my bones. I want to stick with the drug I take to keep the pain down to a dull roar and I do NOT want needless needles offered as an alternative. I’m quite sure that anyone who suggested such a thing would feel The Wrath of Cane.

I also found it disturbing because I lived in Cleveland for eight years. Even though I havne’t [sic] lived in Ohio for 20 years, my wife and I still have friends there, —Orac, B.A., Ph.D

How did that one slip past the auto‐correct? (You’d think he would notice the red‐sqiggly underline.)

[On a side note: one of his Ohioan friends could very well be kfunk, a female having proclivities for cooking—and then eating—large birds with no remorse. This Hansel & Gretel‐type avicide is actually condoned by such people, who actually pay farmers to steal eggs from these aforementioned birds—adding insult to injury. Eggs are a gateway to avicide, leading to the murder and consumption of chickens then progressively larger and larger birds until one is eating 12·lb turkeys every single November. It’s as if they can’t get enough, and kfunk probably even salivates upon seeing Big Bird on Sesame Street—the ‘big kill,’ and similar to how the ostrich and emu are perceived by such with longing on the Discovery Channel. The avicide must be stopped, and the offenders should be tarred and feathered for such transgressions.]

None: Feathers can actually fall off of birds when they are frightened. It has been determined for each one decibel of squawk volume, one‐fifth of a feather is released.⁽¹⁾ This means: one only needs to frighten a bird—perhaps with photographs of a cat—to get feathers quickly!

[1] Randall, V. “The spontaneous dissociation of avian feathers in response to divers stimuli.” Journal of the Totally Absurd (1945)

The latest scam being offered in my area is a Tibetan Herbal Foot Bath, of course offered by a n acupuncturist. It supposed to cure all sorts of pain and treat about everything. Limited time offer of only $20 per session. You don’t need opioids for pain just some herbs from a far away land.

… potatoes …
Eeee! Just a year ago I attended the trial of a woman who, among other things, put potatoes in her kid’s socks, instead of taking him to a doctor. She is currently serving three years in prison for criminal negligence causing death. Spuds is for eatin. An mebbee launchin.

A large potato in a sock makes for a pretty good improvised blackjack, and maybe that’s would should have been used on that mother, imprisoned or not.

We seem to be behind the times here – the latest local S-CAM seems to be salt caves, which are not caves at all, being located in storefronts.
Unfortunately, our local newspaper and its sister cable station have lifestyle “reporters” who appear to be credulous of every kind of woo which our two counties can vomit up.

Perhaps one should look at really effective, non-invasive treatments
Indian hospitals to ‘cure’ patients in ‘Astrology outpatient department’
Indian hospitals to ‘cure’ patients in ‘Astrology outpatient department’ _ Pakistan Today.html

I wonder what would get someone admitted to the inpatient astrology unit and what they do there.

MJD: Wow, even for you, that’s a new frontier in wrong. Did you actually read the books, not the Clif notes version? (Silly question, I suppose, you don’t have the patience for that. Or for actually watching the movies at regular speed.)

Because Tolkien says absolutely nothing about medicine; healing magic does come up, but that’s because the trilogy and the Hobbit are FANTASY. They’re not intended to make any points about the real world, medical practices in the real world. Also, I suspect Tolkien would be horrified at most anti-vaxxers. From all accounts, he loved his kids.

Politicalguineapig85 writes,

Also, I suspect Tolkien would be horrified at most anti-vaxxers.

MJD says,

Have you noticed that Orac’s post is about integrative medicine?

Your obsession with “anti-vaxxers” is admirable but often discombobulated.

Q. What character is politicalguineapig85 most like in the lotr.

A. Shelob.

All anti-vaxxers are her food, and her vomit darkness.

Time for some bait and switch – sort of the reverse of what the quacks do when they hook up the signal generator to the acupuncture needles and claim the result as due to acupuncture. Get people hooked on acupuncture, then change the rules so they can only get continuing treatment paid for if done by licenced physicians, who, unbeknownst to the patients, administer fake acupuncture. Anyone care to wager on the outcomes? Ethics, you shout? Wellllllll … if yer gonna be that way …

Is Botox for migraines covered by Ohio’s Medicaid? Because that actually works and is based on science, not fairies.

Oh good! I tried just searching around, but I don’t know the codes so I didn’t find anything either way.

Based on what I have experienced myself and have seen in clinical practice, I maintain that possibly the best nonpharmaceutical intervention for pain is to try to alleviate the patient’s anxiety. What does the pain mean, how long do I have to wait, why doesn’t anyone seem to be doing something, is there anything that can be done for it? An expression of reassurance, some kind words, a cup of tea, a distraction of attention, can go a long way to help someone to tolerate their pain a little better. Further, if it sounds all softheaded warm fuzzies to you, you probably have no business being around most patients. Very often the patient best remembers and is grateful not so much to the practitioners, but to other staff who behaved in a kindly and concerned manner – the radiology tech, the clerk, the cleaner, the one who takes a little extra effort or time to show concern or offer help. It’s not a placebo because no one who cares about their patients would fake it.
Unfortunately, the woo-peddlers are very good at lending a sympathetic ear, and more importantly, assuring the patient of a cure. Since in reality it’s all they have to offer, they will never be burnt out, dismissive, brusque or too busy.
That’s something real medicine can learn from them.

MJD: “Integrative medicine” is generally code for woo. Anti-vaxxers believe in woo, so it’s still the same topic. Also, FU.

ORD: “they (woo-peddlars) will never be burnt out, dismissive, brusque or too busy.”

In theory. I’ve met some that just don’t listen at all.

Quackery-related update: There are now alarums and reports about a serious “internal power struggle” and a potential impending “end to the dynasty” of the New England Patriots, with an alleged major factor being the tension between Patriots’ staff and quarterback Tom Brady over the role of Brady’s woo-heavy trainer and business partner Alex Guerrero (whose supplement business previously got him in trouble over reported cancer claims).

http://www.espn.com/nfl/story/_/page/hotread180105/beginning-end-new-england-patriots-robert-kraft-tom-brady-bill-belichick-internal-power-struggle

[…] There they go again! I’ve written about this rationale many times. Basically, promoters of pseudoscience seeking to “integrate” quackery with medicine in the form of “complementary and alternative medicine” (CAM) and “integrative medicine” have co-opted nonpharmacologic treatments for chronic pain as somehow being in their bailiwick and used the opioid crisis as an excuse to promote unproven, mystical, and/or pseudoscientific treatments like acupuncture as one of the answers to the opioid crisis. Indeed, the National Center for Complementary and Integrative Health (NCCIH) has recently basically based its existence on CAM being a major component of the answer to opioid addiction, and even the FDA seems to be weakening its stance. Meanwhile, acupuncture advocates are advancing on multiple fronts, recently even getting the state of Ohio’s Medicaid program to pay for acupuncture services. […]

Comments are closed.